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Aetiology and epidemiology of acute gastro-enteritis in Swedish children
Insights
This study identified enteropathogens in most children with gastroenteritis, with rotavirus being the most common viral cause. Antibiotic use, not illness, was linked to Clostridium difficile detection.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Gastroenterology
Background:
- Acute gastroenteritis is a common childhood illness with various potential causes.
- Accurate diagnosis of enteropathogens is crucial for effective treatment and public health management.
- Understanding pathogen prevalence and transmission dynamics informs prevention strategies.
Purpose of the Study:
- To investigate the prevalence of enteropathogenic agents and associated antibody responses in children with acute gastroenteritis.
- To identify specific pathogens, including viral, bacterial, and parasitic agents, responsible for diarrheal illness in children.
- To explore the relationship between pathogen detection, antibiotic therapy, and clinical presentation, as well as transmission within families.
Main Methods:
- Prospective 1-year study involving children with acute gastroenteritis (inpatients and outpatients) and healthy controls.
- Broad panel of diagnostic methods used for enteropathogen detection in fecal samples.
- Serological testing for related antibody responses was also performed.
Main Results:
- Enteropathogens were identified in 77% of inpatients, 63% of outpatients, and 8% of controls.
- Rotavirus (45%) and enteric adenoviruses (7.9%) were the predominant viral agents; Campylobacter jejuni (4.8%) was the most common bacterium.
- Clostridium difficile was associated with antibiotic therapy but not directly with gastroenteritis; unknown etiology infections peaked in autumn.
Conclusions:
- Enteropathogens are frequently detected in children with acute gastroenteritis, with rotavirus being a major contributor.
- Diagnostic methods are essential for identifying causative agents, guiding treatment, and understanding disease epidemiology.
- Further research into pathogen transmission and the role of factors like antibiotic use is warranted.
Abstract:
In a prospective 1-year study, 144 children attending or admitted to hospital and 272 children outside hospital with acute gastro-enteritis and 200 controls were investigated by a broad panel of diagnostic methods for enteropathogenic agents in the faeces and for related antibody responses. Enteropathogens were identified in 77% of the inpatients, 63% of the outpatients and 8% of the controls. Rotavirus and Yersinia enterocolitica were detected significantly more often among inpatients. Altogether, viral, bacterial and parasitic agents were found in 58%, 14% and 1% of diarrhoeal patients, respectively. The isolation of more than one pathogenic agent was uncommon (6.5%). Rotavirus (45%) and enteric adenoviruses 40 and 41 (7.9%) predominated among the viruses, while Campylobacter jejuni (4.8%) was most common among the bacteria. Clostridium difficile and/or its cytotoxin, which were found in 14% of the children with gastroenteritis and in 15% of the controls, were significantly associated with antibiotic therapy but not with gastro-intestinal illness. Diarrhoeal infections of unknown aetiology exhibited a seasonal peak in the autumn. The duration of excretion of enteropathogens was investigated. Rotavirus particles were detectable by solid-phase immune electron microscopy for 14-25 days after the diarrhoea had ceased. Transmission of rotavirus and bacterial pathogens within families was studied also.